Provider Demographics
NPI:1942543160
Name:BASTO, HUMBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:
Last Name:BASTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 NE 215TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1054
Mailing Address - Country:US
Mailing Address - Phone:305-940-0068
Mailing Address - Fax:305-932-3940
Practice Address - Street 1:2300 NE 215TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1054
Practice Address - Country:US
Practice Address - Phone:305-940-0068
Practice Address - Fax:305-932-3940
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36969208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041369100Medicaid
FL041369100Medicaid